A healthy pregnancy does not begin with a positive pregnancy test.
It begins earlier—with the health of both partners, the information they have, and the opportunity to address concerns before pregnancy makes decisions more urgent.
After more than 35 years as an OBGYN, I have met many people who believed they were supposed to stop contraception, start trying, and simply hope for the best. They were rarely offered a preconception visit or taught how their menstrual cycles, medications, medical conditions, family history, and partner’s health could influence the journey ahead.
Preparing for pregnancy is not about achieving perfect health. It cannot guarantee conception, prevent every complication, or overcome every biological limitation.
It is about creating the healthiest possible starting point—and giving yourself more information, time, and choices.
Here are the conversations I wish every prospective parent had before trying to conceive.
1. Begin before you feel completely ready
When possible, start thinking about preconception health at least three months before trying to conceive.
Use that time to review medications, update vaccinations, improve daily habits, and address health conditions. It also reflects the time required for developing eggs and sperm to pass through important stages of maturation.
But if you are already trying—or are already pregnant—do not feel that you have missed your chance. Begin where you are. The next helpful step still matters.
2. Book a preconception appointment
A preconception appointment is different from an annual physical or routine gynecological examination.
It is an opportunity to review:
- Your menstrual cycles and reproductive history
- Previous pregnancies or pregnancy complications
- Medical and surgical conditions
- Prescription and over-the-counter medications
- Vitamins, herbs, and supplements
- Immunization status
- Family and genetic history
- Mental health
- Occupational and environmental exposures
- The health and reproductive history of your partner
- Your family-building goals and preferred timeline
You may not need every test. The purpose is to identify which conversations and assessments are appropriate for you.
3. Review every medication and supplement
Some medications are safe during pregnancy, some require adjustment, and others should be changed before conception.
Do not stop a necessary prescription medication on your own. Suddenly discontinuing treatment for epilepsy, hypertension, diabetes, depression, or another chronic condition can be more dangerous than continuing it.
Bring a complete list to your appointment, including:
- Prescription medications
- Over-the-counter medicines
- Vitamins and minerals
- Herbal products
- Protein, fitness and weight-loss supplements
- Hormones, including testosterone
- Cannabis and other recreational substances
“Natural” does not automatically mean safe. Supplements can contain ingredients that have not been adequately studied during pregnancy, may interact with medications, or may provide excessive doses of certain nutrients.
The male partner’s medications also matter. Testosterone and anabolic steroids, for example, can suppress sperm production.
4. Start an appropriate prenatal vitamin
Canadian public-health guidance recommends that anyone who could become pregnant take a daily multivitamin containing 400 micrograms—or 0.4 milligrams—of folate. Ideally, supplementation begins at least three months before conception and continues during pregnancy.[1]
Some people require a different dose because of their medical history, medications, diabetes, previous pregnancy history, or risk of a neural-tube defect. Higher-dose folate should be taken only on the advice of a healthcare professional.
More is not always better. Avoid stacking several multivitamins or supplements containing the same nutrients without reviewing the combined doses.
A prenatal vitamin supports a healthy diet; it does not replace one.
5. Make sure chronic conditions are well managed
Pregnancy places additional demands on the cardiovascular, metabolic, immune and endocrine systems.
Conditions such as diabetes, hypertension, thyroid disease, PMOS, epilepsy, autoimmune disease, kidney disease and significant mental-health disorders should be reviewed before conception whenever possible.
Good preparation may include adjusting medications, updating laboratory testing or consulting another specialist.
The goal is not to exclude people with medical conditions from pregnancy. It is to enter pregnancy with the condition as stable and safely treated as possible.
6. Review vaccinations before pregnancy
Preconception is an ideal time to check your vaccination history.
Some vaccines can be given during pregnancy, while certain live vaccines—such as measles, mumps and rubella or varicella—are generally given before pregnancy. Canadian guidance advises avoiding pregnancy for at least 28 days after receiving a live vaccine.[2]
Influenza vaccination is recommended for people who are pregnant or planning pregnancy during influenza season. Other recommendations depend on health history, travel, occupation, and current public-health guidance.
Ask your healthcare professional which vaccines you need and when to get them.
7. Strengthen the foundations of health
No single food, supplement, exercise program or “fertility cleanse” can guarantee pregnancy.
However, the same foundations that support reproductive health also support metabolic, cardiovascular and long-term health:
- Eat a varied diet centered on vegetables, fruit, legumes, whole grains, nuts, seeds, healthy fats and adequate protein.
- Include sources of iron, vitamin B12, iodine, choline, calcium and omega-3 fatty acids.
- Move your body regularly and include resistance exercise.
- Aim for consistent, restorative sleep.
- Stop smoking and vaping.
- Avoid recreational drugs.
- If you are planning pregnancy, the safest approach is to avoid alcohol.[3]
- Find realistic ways to manage—not eliminate—stress.
You do not need to change everything at once. Choose one or two changes that are meaningful and sustainable.
A healthy lifestyle supports overall health, but infertility is not a personal failure and should never be blamed on someone’s diet, body size or stress level.
8. Include the male partner from the beginning
It takes two people to make a pregnancy—and two people to prepare for one.
Male reproductive health can be influenced by smoking, cannabis, excessive alcohol, anabolic steroids, heat exposure, metabolic health, sleep, diet, occupational exposures and certain medical conditions.
A male partner should review his medications and health history and improve the same lifestyle foundations recommended for the female partner.
When a fertility investigation becomes necessary, both partners should usually be assessed concurrently. A semen analysis is not something that should be postponed until the female partner has completed every available test.
9. Reduce avoidable exposures without trying to live in a bubble
We cannot eliminate every environmental exposure, and trying to do so can create unnecessary anxiety.
Instead, focus on practical reductions:
- Do not smoke and avoid second-hand smoke.
- Wash produce and vary the foods you eat.
- Avoid heating food in plastic when possible.
- Choose glass or stainless steel for hot food and drinks.
- Wash your hands after handling receipts.
- Use ventilation when cleaning, painting or renovating.
- Follow workplace protection guidance around solvents, pesticides, radiation, metals and other hazardous materials.
- Reduce unnecessary exposure to heavily fragranced products.
- Ask about occupational heat exposure for the male partner.
Professional guidance encourages reproductive-aged women and men to limit exposure to endocrine-disrupting chemicals and air pollution where reasonably possible.[4]
The goal is thoughtful reduction—not perfection.
10. Know when not to wait
For couples without known risk factors, a fertility assessment is generally recommended after:
- 12 months of regular unprotected intercourse when the female partner is younger than 35
- 6 months when the female partner is 35 or older
- A more immediate discussion when the female partner is over 40
But you do not always have to wait six or twelve months.
Earlier assessment may be appropriate if there are:
- Irregular or absent menstrual periods
- Severe pelvic or menstrual pain
- Suspected endometriosis or PMOS
- Previous pelvic infection or reproductive surgery
- Recurrent pregnancy loss
- A history of chemotherapy or radiation
- Sexual or ejaculatory difficulties
- Previous testicular injury, surgery or undescended testicles
- Testosterone or anabolic-steroid use
- A known genetic or medical condition
- Any other reason to be concerned about fertility
Your age, health history and family-building goals should all be part of the decision.
Preparation is not a promise—it is an opportunity
Preconception care cannot control every outcome.
Someone can do everything “right” and still experience infertility, miscarriage or pregnancy complications. Someone else may conceive without having planned or prepared at all.
The value of preparation is not certainty. It is opportunity:
- The opportunity to recognize a condition earlier
- The opportunity to make medications safer
- The opportunity to improve the health of both partners
- The opportunity to understand your reproductive timeline
- The opportunity to make informed choices before those choices become urgent
That is what I wish every patient knew before trying to conceive.
Join me at the National Women’s Show
This is the final article in my Before the Positive Test series leading up to my presentation at the National Women’s Show in Ottawa on Sunday, October 18.
I will be speaking on the Life & Learning Stage about what I wish people knew before trying to conceive. You can also visit me at booth 1217 continue the conversation and learn more about my book, Optimize Your Fertility Naturally: A Holistic Guide to Achieving a Healthy Pregnancy.
A healthy pregnancy may begin with a positive test—but the opportunity to support it begins much earlier.
This article provides general education and is not a substitute for individualized medical advice, diagnosis or treatment.
Dr Marina OBGYN
References
- Public Health Agency of Canada. “Folic Acid, Healthy Pregnancy and Neural Tube Defect Prevention.” Updated 2025. Canada.ca
- Public Health Agency of Canada. “Vaccination and Pregnancy: Before Pregnancy.” Updated 2026. Canada.ca
- Public Health Agency of Canada. “Fetal Alcohol Spectrum Disorder: Prevention.” Updated 2025. Canada.ca
- Practice Committee of the American Society for Reproductive Medicine. “Optimizing Natural Fertility: A Committee Opinion.” Fertility and Sterility. 2022;117:53–63. ASRM
- Public Health Agency of Canada. “Preconception Health: Health Before Pregnancy.” Canada.ca
